How to Find Your First Attending Job After Residency: A Step-by-Step Action Plan
Related Articles
The transition from residency to your first attending job is a significant milestone—and often one of the most daunting. After years of structured training and evaluation, suddenly you’re expected to navigate contracts, benefits, and long-term career choices. You may have learned how to manage DKA and AKIs in residency, but they didn’t tell you how to review contracts and negotiate salaries.
If you’re feeling a bit overwhelmed by it all, take heart. The good news is that with a little planning and guidance, you can learn how to navigate the path from residency to your first attending job without too much trouble. This blog outlines a general timeline and action plan for each year of your training so that when it comes time to find a job, you’re ready to go.
*Disclaimer: This blog post is intended for informational purposes only and does not constitute legal, financial, or career advice. Every resident’s journey and job search experience is unique. Factors such as specialty, geographic preferences, visa status, personal goals, and market demand can significantly impact the process. The information may not apply to all individuals or situations. Residents are encouraged to seek personalized advice from mentors, program directors, and professional organizations relevant to their specialty.
PGY-1
During PGY1, the whirlwind of adapting to residency life often leaves little time for long-term planning, but it’s actually a key period to start exploring your post-residency path. One of the biggest decisions you’ll eventually face is whether to pursue a fellowship or to enter the workforce directly as a new attending.
While this decision doesn’t have to be finalized in your intern year, it helps to begin reflecting on your interests, lifestyle goals, and long-term vision for your career.
Define your career goals
In a broad sense, PGY-1 is a great time to start thinking about what you really want to do in your chosen field. Are you drawn to complex, specialized cases that require deep, focused knowledge? Or do you find satisfaction in managing a wide range of conditions and developing longitudinal relationships with patients?
Learn from fellows and attendings
Talking to fellows and attendings in various subspecialties can offer valuable insight into the day-to-day realities of different paths. In the coming years of your training, electives will also provide hands-on experience that either solidifies your interest or helps you rule out a field.
Evaluate your lifestyle and financial aspirations
Lifestyle and financial goals are also important to think about during PGY-1. For example, should you do a fellowship? They often come with additional years of training, which means a delayed attending salary and continued long work hours. However, they can lead to higher long-term earnings, academic opportunities, and more specialized practice.
On the flip side, becoming a generalist or hospitalist after residency offers earlier financial boons and greater flexibility, which may be appealing depending on your personal circumstances.
By starting to think about these things during PGY-1, you give yourself space to gather information, build mentor relationships, and seek experiences that’ll guide your decision-making. Whether you’re drawn to the depth of fellowship or the autonomy of attending life, your intern year is a great time to begin aligning your choices with your goals.
PGY-2 (~15-18 Months Before Graduation)
PGY-2 is a good time to start refining your career goals. By now, you’ve (hopefully) experienced a variety of clinical settings and developed a clearer sense of what interests you.
Consider your ideal work environment
PGY-2 is a great time to start asking yourself things like:
Do I prefer the pace and variety of a community hospital, or the academic environment with teaching and research?
Would I thrive in a busy urban practice, or does a smaller, rural setting appeal to my values and lifestyle?
Second year is when you should start envisioning the kind of professional and personal life you want to build after training.
PGY-2 is also a good time to evaluate what kind of work-life balance you hope to achieve. Are you aiming for a flexible outpatient schedule, or do you enjoy the structure and team dynamics of inpatient care and working a 7-on-7 off kind of schedule? Consider how your visa status, family obligations, or geographic preferences might shape your decision-making. These factors can help narrow your focus as you explore potential programs or job opportunities.
Build your professional toolkit
PGY-2 is also the time to polish your application materials. Update your CV to include your training, procedure logs, any teaching roles, quality improvement projects, or scholarly work you’ve taken on. Even if you’re not applying just yet, drafting a general cover letter can help you articulate your interests and goals, making it easier to tailor when the time comes to submit an application.
Don’t underestimate the power of professional networking during PGY-2. Refresh your LinkedIn profile, and start connecting with alumni, former residents, or faculty members who are working in your areas of interest. Reaching out for informational interviews or career advice can provide perspective and potentially open doors for future job or fellowship opportunities. By investing in these steps now, you’ll be well-positioned for a smooth transition into PGY-3 and beyond.
As you refine your career goals during PGY-2, consider taking time to enhance your CV in ways that align with your aspirations. If you’re considering a future in academic medicine, look for opportunities to engage in research, quality improvement projects, or case reports that could lead to presentations or publications. These scholarly activities not only demonstrate your commitment to advancing the field, they make you a more competitive applicant for fellowship or faculty roles at academic institutions.
Gain leadership and volunteer experience
Leadership experiences are another powerful addition to your CV. Consider pursuing a chief resident position or volunteering for committee work within your residency program. These roles showcase your ability to lead, manage teams, and advocate for your peers—qualities that are highly valued when you’re applying for an attending role.
Furthermore, don’t overlook the impact of community service and mentorship. Whether you’re involved in a pipeline program, organizing health screenings, or mentoring medical students, these experiences highlight your dedication to service and teaching, which are key components of an academic or leadership-focused career.
By proactively seeking out these opportunities during PGY-2, you not only strengthen your CV, you also clarify the kind of physician leader you hope to become.
Early PGY-3 (~12 Months Before Graduation)
As your PGY-3 year progresses, it’s wise to start keeping an eye on the job landscape, even if you’re still deciding between fellowship or going straight into practice.
Start the job search
Set aside time each month to browse job boards online such as PracticeLink or Doximity. These platforms can help you get a sense of what’s out there when it comes to types of roles, locations, compensation trends, and expectations, so you can apply accordingly.
Take advantage of job fairs, both virtual and in-person, especially those hosted by your specialty’s professional societies or nearby hospitals. These events often feature recruiters and department staff who are actively looking to hire, and usually will come with a nice meal. Attending gives you the opportunity to network, gather information, and fine-tune what you’re looking for in your first attending job.
Talk with mentors and faculty
Your mentors and faculty are some of the most valuable resources you have during this phase of career exploration. Have informal chats or schedule a formal job/career conversation with those you trust to get their perspectives on different practice models such as academic vs. community, outpatient vs. inpatient, and private practice vs. contractor positions.
Also, don’t hesitate to ask if they know of colleagues, former trainees, or contacts at institutions or practices that are hiring. Faculty often have broad professional networks and may be able to introduce you to physicians who are actively recruiting or they can share their own experiences working in specific regions or settings.
Mid PGY-3 (6–9 Months Before Graduation)
Apply and interview with confidence
You can’t wait for the perfect job to land in your inbox, so be proactive. Reach out directly to practices, department staff, or recruiters with your updated CV and a brief, personalized message expressing your interest. Whether it’s a hospital group, academic institution, or private practice, showing initiative is usually taken as a positive sign.
As interviews begin, preparation is key. Make sure you understand different compensation models, including base salary, incentives, and any potential bonuses or profit-sharing arrangements. Think carefully about what matters most to you, whether it’s schedule flexibility, case volume and patient variety, loan repayment, or long-term growth opportunities. And have thoughtful questions ready to help you assess how the job will fit!
Late PGY-3 (~3-6 Months Before Graduation)
As residency winds down, the focus shifts from exploring to executing. During this time, you’ll move from interviewing to negotiating and finalizing your first attending contract. This is an important moment to slow down, read the fine print, and, if possible, consult a healthcare contract attorney who can offer a professional review to help ensure you’re protected and that your contract terms align with your career goals.
Pay special attention to clauses related to non-compete restrictions, which may limit your future job options in a geographic area. Understand the termination notice period—how much advance notice you or the employer must give if either party decides to end the agreement. Also ask about relocation packages, bonuses, and malpractice coverage.
Plan for a smooth transition
Administrative prep is just as important as any career decision. Submit your medical license and DEA applications as early as possible, as these are costly and can take months to process (especially during peak times when many new grads apply).
Coordinate your housing and moving timeline early if you’re relocating, and give yourself adequate buffer time to settle in before starting your new job (locate the grocery stores, some good restaurants, a nice park perhaps).
Prepare for boards
Finally, don’t forget to block time for board exam prep. Carve out dedicated study time and schedule your exam date in a way that doesn’t conflict with moving, onboarding, or starting your new role. Depending on your specialty, boards may fall right after graduation or in the early attending months.
Your job will likely be contingent on you becoming board certified, which means passing your board exam. For more personalized support, meet with one of our certified board exam tutors who can help keep you on track and increase your likelihood of passing on the first try!
Final Thoughts
The hunt for an attending position as you near the end of residency can feel intimidating, but it doesn’t have to be. By breaking the process down into manageable steps and starting early, you can find a role that fits your goals and sets you up for long-term success.
Remember, your first job doesn’t have to be your forever job. It just needs to be the right next step as you enter attendinghood. Good luck, and be sure to reach out if you have any questions!
⭐ For even more post-residency tips, check out this other post on the blog: The 5-Step Guide to Thriving After Residency Graduation
Rosh Review is a board review company providing Qbanks that boost your confidence for your boards and beyond. Get started with a Rosh Review free trial to the Qbank of your choice (no credit card required!) and gain access to board-style practice questions, detailed explanations, beautiful medical images, and more.
By Mike Ren, MD
Comments (0)